title: Depressive, functional status, and neuropsychiatric symptom trajectories before an Alzheimer's disease diagnosis.
abstract: OBJECTIVE
  This short report relied on multiyear data from the National Alzheimer's Coordinating Center - Uniform Data Set (NACC-UDS) to examine whether significant changes occurred in functional status, neuropsychiatric symptoms, and depressive symptoms in the years before receiving an Alzheimer's disease (AD) diagnosis.
  
  
  METHODS
  The secondary analysis used a retrospective cohort design. The NACC-UDS is a publicly accessible, longitudinal database that includes standardized data on neuropsychiatric symptoms, functional status, and depressive symptoms for Alzheimer's Disease Center (ADC) participants in the USA based on their annual visits from 2005 to 2011. ADC participants were considered diagnosed with AD if a follow-up data form indicated an affirmative response to whether the ADC participant had 'probable AD (National Institute of Neurological and Communicative Disorders and Stroke (NINCDS)/Alzheimer's Disease and Related Disorders Association (ADRDA))' or 'possible AD (NINCDS/ADRDA).' This yielded an analytic sample of 2478 individuals (139 with an eventual probable AD diagnosis, 109 individuals with an eventual possible AD diagnosis, and 2230 without any AD diagnosis) representing a total of 11,358 visits/points of data.
  
  
  RESULTS
  Multilevel linear models revealed significant decreases (p < 0.05) in functional status prior to a probable or possible AD diagnosis and significant increases in depressive symptoms prior to a probable AD diagnosis.
  
  
  CONCLUSIONS
  Changes in functional and depressive symptoms were partly independent of cognitive decline. The longitudinal results lend additional support to conceptual and empirical models of pre-diagnosis declines in AD.
authors.affiliation: a School of Nursing, Center on Aging, University of Minnesota-Twin Cities , Minneapolis , MN , USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Gaugler
authors.forename: Martha
authors.initials: M
authors.lastname: Hovater
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Johnston
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Khaled
authors.initials: K
authors.lastname: Sarsour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D010054:Brief Psychiatric Rating Scale; D003625:Data Collection / Q000379:methods; D003866:Depressive Disorder / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D054561:National Institute on Aging (U.S.); D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States